Enroll

Enroll

Your Corner provides initial speech language, feeding and occupational therapy screenings at no cost to you. We’ll walk through your child’s results with you then explore whether regular intervention is the right choice for your child and family.

Your Corner accepts Blue Cross Blue Shield of Nebraska insurance. We can also provide you with information on how to use your out of network insurance benefits, or families may pay a monthly tuition. We are not accepting Medicaid clients at this time.

Ready to find out more? Let’s talk. Submit the enrollment form below to begin the process of your free screening

Enrollment

I am interested in finding out more about enrolling my child in one of Your Corner’s services

Speech Language therapy services

Occupational therapy services

Feeding therapy services

My child

Is currently qualified for speech and language services through Lincoln Public School’s early intervention program and has an IEP/IFSP. I will provide a copy of my child’s current IEP/IFSP for treatment planning purposes.

Is not currently enrolled in an Early Childhood Special Education program, but I have concerns about their developing speech/language, feeding or fine motor skills.

My Child

Child's name

Date of birth

Date of birth: Month

Date of birth: Day

Date of birth: Year

Grade

Primary teacher’s name

Parent/Guardian

Name(s)

Address

Email(s)

Phone number(s)

Concern

Primary concern

Does your child receive speech/language, feeding or occupational therapy services currently?

Yes

Where

Therapists name

Does your child have any known diagnoses or chronic medical conditions?

Does your child currently have or is eligible for Medicaid?

Yes

What is your current insurance carrier?

Your Corner will contact your child’s school and teacher to arrange a convenient time for an initial screening. Watch for an email from Your Corner to tell you when this meeting has been scheduled.

Screening Permission

I understand and consent to a one-time screening of my child’s speech and language skills in their classroom. There will be no charge for this screening.

Parent/Guardian signature